A Multi-Purpose Arthritis Center will be established at the Dartmouth-Hitchcock Medical Center (DHMC). DHMC is located in and dominated by a rural environment. The programs of the Arthritis Center will reflect the realization that DHMC is at the interface with the community and has a major role to play in determining standards of health care in the Upper Connecticut Valley. Many programs will be directed at both educational and community goals. One such program, of major interest to us, will involve training and utilization of Arthritis Care Specialists - registered nurses trained to do rheumatologic examinations, and to be an effector arm in the community for physicians and therapists. Special emphasis also will be given to undergraduate exposure to connective tissue disease at Dartmouth Medical School, post-graduate education within community hospitals, and maximal utilization of INTERACT, the inter-institutional television network in the Upper Valley. An extra-mural fellowship in rheumatology will be planned and carried out. Research programs of the Connective Tissue Disease Section (primary interests in the proliferative, destructive lesion of rheumatoid arthritis), the orthopaedic Bioengineering labs (primary interests in host reaction to prosthetic implants) and the Departments outside the usual rheumatologic sphere of influence (e.g. Study of Sleep Abnormalities in Fibrositis with the Department of Psychiatry) will be fused for the first time at Dartmouth. We believe that the establishment of an Arthritis Center at DHMC will be catalytic in molding already existing programs into a learning, teaching and serving force here which can positively affect patient care outside as well as within our walls.